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Sensory Motor Development in Autism

Yesim Fazlioglu and M. Oguz Gunsen
Trakya University Deparment of Special Education Edirne,
Turkey
1. Introduction
Autism is a syndrome that emerges in the first three years of life and is defined by a
pattern of qualitative abnormalities in reciprocal social interaction, communication, and
repetitive interests and behaviors. One of the characteristics which is most noticeable in
those young children with autism who remain severely intellectually disabled is their
propensity to engage in repetitive self-stimulatory actions, such as rocking, twirling
objects or flapping their hand and finger. These actions appear to have no constructive
use other than to provide some sensory stimulation (Attwood, 1993). Sensory and motor
abnormalities commonly found in autism. These abnormalities have been described in the
perception of sound, vision, touch, taste, and smell, as well as kinesthetic and
proprioceptive sensations. These include reports of both hypo and hyper responsiveness
to sensory input, raising the possibility that two groups of sensory responders may exist
within the autism spectrum.
Comparing children with autism and children with other developmental disorders have
concluded that prototypical developmental profile for children with autism is one of motor
skills that are relatively more advanced than social skills, even when all delayed. Early
hand-eye coordination significant predicted later vocational skills and independent
functioning, while earlier fine motor skills predicted later leisure skills. Also motor
development plays an important role in learning young children typically use motor skills
to explore the environment, engage in social interaction, engage in physical activities, and
develop basic academic skills. Unusual sensory responses are common concerns in children
with autism. Given that most educational environment involve many sensorial demands,
such as: noise level in classroom (ONeill & Jones, 1997; Dawson & Watling, 2000).
These problems make the life of the child and his/her family more difficult and they
prevent the child from learning new skills and having interaction with the environment. In
solving sensory problems, it is important to support autistic children in gaining different
sensory experiences. Sensory integration therapy program is important children with
autism. Because the sensory integration therapy provides a child-centered and playful
approach that is often appealing to even the most unmotivated or disengaged child (CaseSmith & Brayn, 1999; Fazlioglu & Baran, 2008).
This chapter will focus on sensory and motor development in autism, which are aimed at
determining sensory problems that characterize the disorder. In addition, this chapter will
comprehensive sensory integration therapy approaches, given the intensity and importance
of these intervention in treatment planning.
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A Comprehensive Book on Autism Spectrum Disorders
2. Definition and development of sensory integration

Sensory integration theory was developed by Jean Ayres during 1970s. The aim of this
theory is to stimulate specific locations of the body in order to ensure coordinated function
of sensors. Ayres developed this theory in an attempt to better explain the relation between
the sensory process, neural functions and behavior. Sensory integration treatment is used
for children with autism as well as those with hyperactivity, cerebral palsy and premature
birth (Fisher & Murray, 1991; Kranowitz, 1998; Bahr, 2001).
Sensory integration is a neurological process which compasses the analysis, synthesis and
organization of the data received from the body and the environment. Sensory integration
takes place in central nervous system. Sensory integration takes role in developing body
perception, selection of concurrent stimuli, and the ability to act in convenience with the
environment. Sensory receptors receive all the data from the body. Data flows through the
sensory neurons in the central nervous system. Brain promptly analyses, collates associates
and integrates the respective sensory signals through neurologic processing. Consequently,
motor neurons send a signal to the brain. The body gives a sensory motor response to the
signal. For instance; when someone says I love you, vocal response is I love you, too
whereas the emotional response is euphoria. Normal child is born with a perfect sensory
system. Sensory integration mechanism in childhood continues through lifetime (Kranowitz,
1998).
It develops through new activities in daily life, experimenting, effort and exploring the
environment. Each new piece of experience stirs the sense of achievement in the child.
Developmental mechanism of sensory integration does not change and the development is
constant. An example for the development of sensory integration may be a building. First,
the foundation of the structure is laid which is followed by the construction of the first,
second, third and fourth floor respectively. Constitution of the sensory integration is similar.
Dr. Ayres defines the integration mechanism in four levels:
First Level: This level constitutes tactile, balance and movement (vestibular), deep sensory
(proprioceptive), visual and auditory sensory. Babies begin to show interest in sensorial
information as of second month therefore forming a basis for future learning skills. In this
period, initial informative is the skin. Touch stimulus produce a fine feeling on the skin and
around the mouth. The child is delighted with sucking. As a result, a strong bond is formed
between the mother and the child. Thus, the baby learns to eat, hug, friendship and positive
reaction. The baby is informed about vestibular and proprioceptive sensories through
movement. The baby predicts and imitates the mothers facial expression with immature
visual expression, beginning to develop movements including eye movement. At this time,
the baby starts to recognize close objects, learns to follow the movement of his/her relatives
and gains the feeling of trust in them. In the absence of the guidance of these sensories, it is
difficult for the child to focus eyebeam, follow or move an object (Temel, 1992). Vestibular
and proprioceptive sensories also influence the posture and muscle tone. Babys actions in
this period are automatic and situation-based. The child learns new movements. Vestibular
sensations are instrumental in attaining the skill of feeling safe against the gravity by the
muscles and joints. The baby learns to establish connection with the surface when lying and
crawling. Therefore, the child feels safe.
Second Level: Tactile, vestibular and proprioceptive functions are essential in obtaining
sensorial balance. In the emergence of distortion in the functions of these three systems, the
child may provide insufficient reaction to the environment. In connection, the child may be
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observed to stage hyperactivity or introversion (Temel, 1992). Body perception (body

awareness) consists of bilateral coordination of the body, hand preference (laterization) and
motor planning (praxis). As of the first year, after achieving integration of the simple
sensations in the first level, body perception and awareness start to develop. Body
perception is the intellectual image of the position of body parts. Visual reactions assist in
understanding how body parts move and their interactions with each others as well as
developing a sense of self-identity. Developing body awareness enables bilateral integration.
In this process, the child learns to use both sides of the body symmetrically. Bilateral
integration is a neurologic function essential for developing bilateral coordination and
behavioral skills. For instance; baby needs to develop bilateral integration in order to be able
to swing or hand over the rattle.
Another function of bilateral integration is hand preference (laterization). Laterization is the
detection that one side of the brain is favored. As laterization develops, the child begins to
determine which hand is favored. The baby is then able to distinguish which hand is
preferred. For instance, the baby may swing the rattle with one hand, while playing with
his/her toes with the other hand. The childs body and neck rest above against the gravity. As
head control develops, the babys head rises and rotates around the body. Stabilizing the neck
assists eye fixing. As a result, the child acquires the ability to gaze and inspect. First, the baby
starts to creep, then crawls. Hands and legs act in coordination. The baby uses both sides of the
brain while these movements stimulate the development of bilateral coordination, developing
tactile, vestibular and proprioceptive sensories and motor planning (praxis).
Before engaging in a movement, the child thinks about how to do it. Afterwards, the baby
actualizes the movement impulsively. For instance; development of motor planning is
necessary for the child to roll on the ground. At first, the child practices turning and is able
to roll without much effort afterwards. Thanks to the organization of the sensories, the
childs activity level is better collated. Focusing duration and emotional intrepidness
increases. In this period, the child may sit on the car seat and is able to distinguish between
family members and foreigners.
Third Level: Sensory integration is a sustained and continuous process. Each level of
integration enables the use of previous level (Temel, 1992). As the child grows, perception
and understanding of the information received through the senses reaches higher levels.
Expansion of the babys environment urges the organization of sensory perception and
distinguishing skills. In this level, the child has developed the ability to follow a speech
completely and understand the language. Listening to a language user is the key skill in
developing the ability to speak and understand the language. Hearing and language center
of the brain is assisted by the vestibular system as to what is heard. Therefore, a problem in
the vestibular system may lead to deficiencies in language development. Sensory integration
disorder may prevent the child from feeling the position of the tongue inside the mouth as
well as lip movements. Similar to speech and language, visual perception is a product of
early sensory integration (Temel, 1992). In this period, visual senses convey significant
importance. During this stage, the child has developed the ability to interpret visual input,
understand peoples and objects position in the space as well as eye-hand coordination. The
child can use paints, produce simple drawings, catch a ball or pour juice into a glass.
Development of eye-hand coordination contributes to the development of visual motor
integration. As an example, we may point to the childs ability to place jig-saw pieces. At the
age of three, the childs simple skills continue to develop and improve. The child is then
ready to build a structure made of blocks.
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Forth Level: The latest product of sensory integration is the academic skills. These include
complex motor skills, organizing focus, organizing behavior, specialization of both sides of
the body and the brain, visualizing an event, developing self-identity and self-control. These
skills develop in time. Reaching the age of six, the childs brain is sufficiently proficient for
such skills. Proficiency refers to the brain attaining greater efficiency in special functions
while being potent and purposeful. In this level, the childs eyes and ears stand as primary
teachers. Also, the child has organized the ability to distinguish concerning the touching
sense.
Proprioceptive, vestibular and touching senses assist the development of motor
coordination. In this period, the child can jump, run and play games with friends. The child
can also button up, pull zipper and may use on hand more than the other. The child can also
copy shapes and symbols using a pencil, may visualize past and future situations (for
instance; we played football last night; I will have a bath tonight). Social skills are also
developed in this period. The child can share ideas or toys with other people. Sensory
integration is continually organized and structured throughout the life. When faced with
exotic situations, the child learns to adapt and cope through sensible ways. The child holds
positive feelings for him/herself and is ready for school attendance (Fisher & Murray, 1991;
Kranowitz, 1998; Bahr, 2001).
3. Effects of sensory integration deficiency

Sensory integration deficiency (SID) is the inability to sufficiently perceive brain senses. SID
is not considered as brain damage. This condition is named J. Ayres, brain dyspepsia
(Royeen & Lane, 1991; Kranowitz, 1998; Bahr, 2001). The inability of the brain in processing
sensory input sufficiently causes difficulties in effective management of behaviors. In cases
when sensory problems are severe, the child may suffer from mental defects. Although
sensory integration deficiency is a functional insufficiency, this condition does not mean
total annihilation of the functions. Children with functional defects possess the same neuron
count as healthy people, but the neurons cannot function cooperatively (Temel, 1992).
We may speak of four neurologic mechanism disorder considered to be related to autism in
children with sensory integration deficiency. First of these is the deficiencies in registering
and integration of sensory information (canalecstasia). Second are the problems concerning
the proper transfer of stimulants to the right locations. The third one is anti-social behavior
such as behavioral disorders and inability to initiate bilateral relations which are considered
to be in connection with serotonin system disorders. The forth neurologic disorder observed
in children with autism is the perceptual selectivity issue. The child may have difficulty in
focusing on a specific point (Waterhouse et al. 1996). There are a variety of factors believed
to cause sensory integration deficiency. These are:
First factor; it refers to the case when the brain has difficulty in responding to too much or too
little sensory information. Excessive information input is called hypersensitivity. In this case,
aversion from the sensory stimulant may be observed. A low level of sensory information
input is named hyposensitivity. In such cases, excessive self-stimulating may be needed.
Second factor; it is the neurologic organization disorder. In this case;
Brain may not receive senses due to connection failure.
Brain may receive sensory signals, but reception may be inconsistent.
Brain may receive sensory signals consistently, but cannot establish the appropriate
connection necessary to respond to other sensory signals.
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The childs extraordinary answer to an ordinary question may reveal hypersensitivity,

hyposensitivity or a combination of both. In case of hypersensitivity, the child may react with
fear, irritability and protesting, negative, dissocial or introverted behavior. The child may be
distracted by perceiving all the stimulants in the environment. Hypersensitive child feels
disturbed when touched, avoids people and the environment. Changes in daily routine, crowd
and noise are likely causes of anxiety. The child experiences difficulty understanding gestures
during communication. The child may also have difficulty focusing on a purposed activity.
Recent research proposes that hypersensitivity may relate to cerebellum. Brain doesnt need
the sensory signals from a movement to know the location of the body and the limbs. When
limbs are moving, cerebellum predicts the consequences of the body movements and on this
basis, sorts out sensory signals occurring from a touch to the body. For instance; while
reaching out to grab an object afar, if we accidentally hit our other arm, we feel no anxiety or
fear. In this moment, cerebellum determines the cause of the action as self or external based
on predicting the results of previous motor action. It is predicted that faulty movement
interpretations of sensory signals by cerebellum may be the cause of hypersensitivity
(Fuentes & Bastian, 2007). In research conducted on autistic individuals, consistent
cerebellar damage and Purkinje cell loss was observed which is supportive of this prediction
(Bauman & Kemper, 2005).
In hyposensitivity, the child need more stimulants even to develop simple skills.
Hyposensitive child is prone to touching and feeling.
Children may not demonstrate all these symptoms. For instance; the child may have a
vestibular disorder while having a fine muscle tone. The child may also carry symptoms of
the above mentioned disorders but may not be SID. The child may simply be undergoing
emotional problems. A child may be both hypo and hypersensitive. For instance, a child
may be oversensitive for a soft touch while he/she will not cry when receiving an injection
(Royeen & Lane, 1991; Kranowitz, 1998; Talay-Ongan & Wood, 2000).
This factor; it is the motor, language, sensory product deficiency. Brain is inefficient in
processing these signals. Therefore, it is more difficult to receive feedback. In connection
with insufficient feedback, difficulty in looking and listening, failure to focus on people and
objects, difficulty in processing new information, memory problems, and difficulty in
learning and bilateral interaction with people will be observed.
Although sensory integration disorder has a genetic background, it is also believed that air
pollution, devastating viral infections as well as chemical wastes taken into the body may
cause these functional disorder (Temel, 1992). In some cases, sensory integration problems
are seen intensively. These cases are:
Autism,
Attention deficit hyperactivity disorder,
Difficulty in learning,
Hearing and language problems,
Articulation disorders,
Visual problems,
Nutrition problems,
Sleeping disorders,
Allergies.
Sensory have to function cooperatively. It is crucial that the brain receives balanced and
systematic information (a well-balanced diet). Brain feeds on the functioning of many
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sensories. Dr. Ayres points to three important body-based sensory systems. These are tactile,
vestibular and deep (proprioceptive) sensories. These sensories convey important tasks for
the healthy development of a child. The functions of these sensories can be divided into
three categories;
1. Proprioceptive sense: It is the processing of the information concerning the body position
and body parts. It contains information relating to movement positions received from
the muscles, joints and bonds. Proprioceptive stimulants are followed by motor
response such as stimulation or inhibition.
2. Surface sense: Information of touch, heat, pressure and pain is seized by receptors
localized in the skin. Information concerning surface sense is transmitted to
corresponding areas of the central nervous system.
3. Cortical sense: An example for the cortical sense is the ability to recognize 3D objects by
touching (stereognosis). If the child has developed stereognosis, he/she can figure out
the surface shape, size or solidity of an object (Kayihan, 1989; Royeen & Lane, 1991;
Kranowitz, 1998).
4. Sensory problems in autistic children

Autistic children experience a variety of problems.
4.1 Auditory problems
Autistic children may show complex reactions to sound while showing no reaction to some
sounds during early childhood which leads their parents to believe that the child has
hearing impairment. Children with autism may seem unable to hear. In some cases, the
child may not even react to his/her own name. In light of the research conducted on this
subject, it was found that autistic children cannot separate sounds in noisy environments
and are disturbed by it. During the hearing tests conducted, it was revealed that autistic
children possess a normal hearing ability while experiencing problems perceiving complex
sounds such as speech. Children with autism do not pay attention to the speech language.
They can express their wants through mimics and objects. Auditory problems in autistic
children are related to speech tone and pitch (Miral et al., 1994, Grandin, 1996a).
As a result of the hearing tests conducted; peripheral hearing impairment may be detected
in some children, though it is generally seen that these children have no organic problems
with their hearing ability (Klin, 1993). However, autistic children may fail to react to some
sounds as they are not sufficiently sensitive to environmental sounds stimulants. Auditory
reactions may manifest as being irritated in crowd and blocking ears in the presence of high
levels of sound. In a study conducted by Rosenthall et al., hearing ability of 199 adults (153
male, 46 female) was evaluated. 7.9% of the test group showed mild hearing impairment
while 1.6% had hearing problems in one side and 3.5% had hearing issues on both sides.
Consequently, it is observed that hearing impairment is uncommon among autistic children
(Rosenthall-Malek & Mitchell, 1997).
Autistic children may be easily irritated by high levels of sounds and stressed out by strong
sound tones. Therefore, they may refuse to be present in noisy environment. In connection
with extreme sensitivity to sound, autistic children may have difficulty in following
intentional instructions. These children experience difficulty in oral communication which
may restrain them from following simple commands which may lead to communicative
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problems (Attwood, 1993; Piggot & Anderson, 1993; Kavon & McLaughlin, 1995; Bettison,
1996; Hughes, 1996; ONeill & Jones, 1997; Duchan, 1998; Grandin, 1998; Huebner & Emery,
1998; Koegel et al., 1998; Gresham et al., 1999; Mudford et al., 2000; Anonim, 2003; Fazlioglu,
2003).
4.2 Visual problems
Some autistic individuals experience severe visual disorder. Most of autistic individuals,
who cannot speak, may pretend not to see in different environments. Visual problems are
caused by visual disharmony and color separation disorder. These individuals experience
difficulty in spotting objects with darker colors. In addition, they may not be able to
recognize shadows. Their vision may be compared to a TV with static. They also experience
problems in perceiving visual signals. In autistic children, eyes and retina usually function
properly. These individuals can succeed in visual evaluation tests. Their problem results
from the failure to transmit visual input to the brain (Attwood, 1993; Grandin, 1996a; Senju
et al., 2003).
Although children with autism do not look at human face and many objects in their
environment, it is known that they may view moving, rotating or shiny objects for long
times. It is observed that some are irritated by light and feel more comfortable in dark
rooms. It is also known that some autistic children may cover their ears when encountering
light and covering eyes in the presence of high levels of noise. Visual problems in autistic
children manifest as weak eye contact, sideway looking, blinking and light irritability
(McConachie & Moore, 1992; Wainwright-Sharp & Brayson, 1996; Mitchell, 1997; Case-Smith
& Miller, 1999).
Research conducted on controlling attention when executing an action shows that autistic
children have limited skills in utilizing information received from the stimulants as well as
focusing on a single determinant in selecting a stimulant. A number of researches conducted
over the issue of over-selectivity revealed that mental age in autistic individuals is
influential in the ability to select a stimulant from a specific distance. Autistic individuals
can focus attention on a single, narrow area by distinguishing only one attribute of the
stimulant in the process of determining the color and form of the stimulant in the space.
This attribute is called tunnel vision in autistic children. In relation with this, it is
prominent that failure to focus attention on a single subject and inability to focus quickly on
a new subject are observed effects of this disorder (Rincover & Ducharme, 1986; Martineau
et al., 1992; Waterhouse et al., 1996; Belmonte, 2000).
4.3 Tactile sensory problems
Tactile system is a necessary skill in daily life which ensures protection from danger and
distinguishing the differences between the objects. The first of these skills is the touch sense.
Normal child learns tactile individuation on the basis of how environmental elements feel.
The child begins to recognize the world by feeling the warm touch of the mother, lightly
grown firm beard of the father and the sound of pebble stones when walking. Children with
sensory integration disorders experience difficulty in focusing on the varying attributes of
people and objects as well as distinguishing between them. These children avoid touching to
the point that it is possible. Since their palms are over-sensitive, they tend to inflect their
fingers. Although they want to touch objects to learn, they cannot distinguish between their
visuals. Thus, these children cannot develop fine senses since they cannot attain experience
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through tactile sensory. Movement and touching are the first teachers for a child. If the child
is having problems with tactile sense, it may not be possible for them to learn through
touching. Most of these problems affect the childs academic success and language
development (Kranowitz, 1998).
Tactile senses allow the child to subconsciously realize body parts and their interactions
with each others. The child will develop fine body awareness when tactile senses are
functioning properly. Acquisition of body awareness will allow the child for easy and
intentional movement. The child will know what the situation is about, as well as what
he/she should do about it. In cases where the disorder manifests, the child will undergo
various difficulties. For instance; the child may have difficulty directing limbs when getting
dressed (Kranowitz, 1998).
Motor planning is a prerequisite for all the new movement abilities. The child will plan
his/her movements with an intentional effort, will learn to successfully perform the move
through continuous practice. Therefore, the childs tactile sensory is integrated. For instance,
the child may feel the gymnastic ladder through hands and feet and may successfully climb
it. The more objects the child discovers and touches, the better he will fare in executing
different body movements, motor planning and motor skills. Attaining proficiency in a
motor skill enables new experiments. For instance, after successfully climbing the ladder the
child may use this skill for climbing and skinning down a tree. Children who are vulnerable
tactile sense may experience dyspraxia. Dyspraxia is one of the sensory processing disorders
caused by inability to coordinately execute movements. These children may not be able to
execute the movement or will experience difficulty in organizing or planning the movement.
Thus, they tend to avoid activities necessitating motor planning. Children with tactile
disorder may develop gross motor skills late. They may also fail to learn movements and
play purposeful games (Kranowitz, 1998).
Children will also experience difficulty in using simple tools (such as scissors, paint brush,
fork and spoon). They also have difficulty in developing independent life skills (such as
spilling food when eating). In addition, these children may have articulation issues. Since
they have not matured linguistic skills, they experience insufficiency of fine motor control in
the tongue and lips. Consequently, they tend to use signs rather than words (Kranowitz,
1998).
Tactile system accommodates an important role in the development of perception. Visual
perception is the brain interpreting what is seen. The child will save the attributes and
correlations of objects into his/her memory by touching. Therefore, most of the experience
concerning tactile sense is also related to visual perception. When the child is unable to
receive tactile stimulants, the brain cannot feed on basic information concerning the sense of
touching, therefore experiencing difficulty in analyzing and interpreting tactile senses.
Tactile system is highly influential in childs learning skills in the school. Most objects in the
world need to be hand operated (such as art materials, rhythm instruments, chalk, pencil).
Tactile experience constitutes the foundation of the childs lifetime knowledge formation
and guides the acquisition of new skills. Since they will avoid touching senses, children with
tactile system disorder may experience difficulty in learning new skills (Kranowitz, 1998).
Tactile senses are essential in organizing relations with other people. It forms the foundation
of the formation of the bond between the mother and child, touching others and enjoying
being touched. When we are close to people, we learn how to communicate, how to play
and how each individuals character differs from one another. Therefore, we can develop
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meaningful relationships. If the child has tactile vulnerability, he/she may not respond to
physical connection appropriately. Children with tactile system experience problems in
socializing. They may send negative signals to the environment and fail to establish
friendship. Thus, the child will prefer to be alone (Parush et al., 1997; Kranowitz, 1998,
Halker, 2001).
Tactile system disorder occurs when signals received through the skin are not sufficiently
processed in the central nervous system. Children with tactile disorder may refrain from
touching objects and people or being touched. These children cannot realize the difference
between dangerous and pleasing situations. They may also have difficulty in distinguishing
the physical attributes of objects. Children with tactile system deficiency may manifest one
or more problems concerning tactile sense integration (Royeen & Lane, 1991; Kranowitz,
1998; Bahr, 2001).
Normally developing infant will react to the mothers touch or speech in form of voice or
smile. In later months, the baby will lift arms to be cuddled. The baby enjoys engaging in
human relations. However, autistic children reacting to being touched or cuddled refuse
physical connection and avoid having relations with the environment. Although autistic
children may provide various reactions to the sensory stimulants in their environment; it is
revealed that they tend to use tactile and olfaction senses when recognizing a new object. It
is observed that these children may hold, smell and sometimes bite or lick an unrecognized
object to learn about it. Some autistic children enjoy touching, while others prefer to be
touched. In some cases however, the child may strongly refrain from both. For some
children, the mildest touch is enough to be scared. These children may be scared by soft
touches while showing no reaction to painful situations. This kind of case is caused by a
disorder in the bodys self-anaesthetizing system which is called opiate system. Some
autistic individuals may strongly refrain from self-care activities such as hair cut, washing
face, nail clipping along with wearing braided cloths (Grandin, 1996b; Kientz & Dunn, 1997;
Korkmaz, 2000a).
4.4 Vestibular systemic problems
Vestibular system provides information about the individuals head and body location as well
as their relation in the space. This system receives sensory signals from joints, eyes and body
concerning movement and balance. These signals are sent to the central nervous system to be
used. Vestibular system also provides information about whether the individual is moving or
stable, movements of the objects and their relation to the body as well as the direction and
speed of the individuals movement. Vestibular signal receptors are located in vestibular in the
inner ear. These receptors record each movement and the changes in the position of the head.
These receptors are stimulated by movement and gravity.
Dr. Ayres states that the gravity has a universal power in life and plays an important role in
every movement. Receptors concerning gravity are responsible for a variety of tasks such as
retaining stance, ensuring the reception of movements so as to enable sufficient movement
and evading hazards by perceiving vibrations in the air. Vestibular and auditory senses
contain movement and acoustic vibrations. Vestibular system is a consolidative system.
Activities related to this system form a basis for other experience. If the vestibular system is
not functioning properly, problems may present in the interpretation of other senses.
Vestibular disorder occurs when the signals from the inner ear are not sufficiently perceived
by the brain. Children with vestibular disorder are inefficient in integrating information
concerning movement, gravity, balance and space. These children are oversensitive or
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insensitive to movement. They may also present both cases. These children may not develop
postural response, may never crawl, or may be delayed from learning to walk. They may
collapse on their seat and their head may fall on the hands when seated. In kindergarten
activities, they will be clumsy, uncoordinated and gawky. They often fall down when
walking, will hit the furniture and collapse when moving. Also, their eye movement is
affected by the insufficiency of the vestibular system. In accordance they may experience
visual problems. For instance, they may be inefficient in focusing sight on a moving object.
These children may not develop the brain functions requisite for moving the eyes sideways.
In line with this, reading issues may be observed.
Vestibular disorder may also cause difficulty in understanding a language. Linguistic issues
may lead to problems in communication and learning to write and read. Children with
vestibular vulnerability cannot calm down. The reason for this is the failure in the childs
brain in utilizing vestibular signals properly. Children with vestibular systemic disorder
experience a variety of problems concerning the integration of sensories (Fisher, 1991;
Kranowitz, 1998; Bahr, 2001). These children;
1. May be oversensitive to movement. This case can manifest itself in two ways;
Failure to tolerate movement
Insecurity towards gravity.

2. May be insensitive to movement. They will have high tolerance to movement and
desire to move.
Autistic children may demonstrate slow walking, unusual walking, shorter strides,
increasing knee flexion as well as unusual upper extremity positions (Vilensky et al., 1981).
Children experiencing such difficulties may feel vulnerable when their feet are not on the
ground. This insufficiency of basic sense causes the child to form gravitational insecurity.
Gravitational insecurity is the abnormal reactions like stress or anxiety towards the
possibility of falling. The movement is not fun, but scary for the child. When the childs
head moves, he/she will respond as I am falling, I cant control myself. The child reacts to
this situation by avoiding or fighting back. The child may be nervous or angry and may
avoid moving, may refuse to ride a bike or play with the slide. Children with similar
problems frequently present emotional and behavioral problems. They continuously worry
about falling down (Fisher, 1991; Kranowitz, 1998; ORoidon, 2000; Bahr, 2001).
Vestibular system also provides information about how to stand. To remain standing, brain
conducts a subconscious physical adaptation resulting in the balance, sustenance of this
balance and easy movement. Children with vestibular systemic disorder present problems
with balance and movement. It is observed that these children are uncoordinated and
clumsy in activities that require movement (Gillberg, 1989; Fisher, 1991; Ghaziuddin et al.,
1994; Miyahara et al., 1997; Brasic & Gianutsos, 2000; Rinehart et al., 2001; Korkmaz, 2003).
These children experience problems when rolling a football and pressing someone during
the game. Their grip is weak and need to spend a lot of energy resisting the gravity. Autistic
children do not develop and preference. They occasionally use right or left hand to eat, write
or hurl an object. Bilateral coordination issues may cause the child to experience problems
jumping from a high place using both feet, catching a ball with both hands and clapping.
They may also have difficulty holding a paper fixed when writing or using a scissor with
one hand. Bilateral coordination deficiency is commonly misinterpreted as learning
difficulty (Fisher, 1991; Kranowitz, 1998; Ryoichiro et al., 2000; Bahr, 2001; Dewey & Hauck,
2001).
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Vestibular system is essential in processing the hearing. Children with vestibular disorder
commonly present language development problems. These children may experience
difficulty in recognizing the differences and similarities of words. They also have problems
listening or following the instructions of the teacher. They may have drawbacks asking or
answering questions. After developing movement skills, they begin to speak but cannot
present a fine speech craft. When balance, movement and motor planning skills are
organized, language and speech craft also draw attention (Fisher & Murray, 1991;
Manijiviona & Prior, 1995; Kranowitz, 1998; Bahr, 2001).
Vestibular system is greatly influential in processing the visual input. Observing the
environment, moving around and active participation to sensory experience practices are
necessary to attain visual-spatial processing skills. Children with vestibular disorder may
experience problems with visual spatial processing skills alongside basic visual motor skills
since the brain cannot efficiently integrate the signals received from the eyes and body. For
instance, they may confuse or mistype the words when reading or writing. They may also
confuse symbols when doing mathematics (like writing + instead of x). The movements
of people and object around him/her may restrain the child. The child may experience
difficulty in activities like climbing a ladder, finding jig-saw pieces, sticking stars on a paper
or picturing an event. The child may fail to find the way to school cafeteria or may run in the
wrong direction when playing basketball. The child acts like lost in the space (Hughes, 1996;
Kranowitz, 1998).
Vestibular system also plays an important role in motor planning. Motor planning (praxis),
is conceptualization, organization and realization of complex and unrecognized movements.
Adapting behaviors for learning new skills may be challenging for the child with vestibular
disorder. For instance, these children can skate, but cannot ice-skate. If the central nervous
system cannot sufficiently process signals concerning balance and movement, brain cannot
figure out how to act in these conditions. Therefore, the child cannot learn the new skills for
planning (Reiss & Havercamp, 1997; Rogers et al., 2003).
Vestibular system also influences the childs emotional confidence acquisition. Every child
possesses emotional confidence from birth. However, children with vestibular disorder
cannot feel this confidence after birth. These children suffer from gravitational insecurity in
connection with hyper or hyposensitivity and cannot organize most of their lives. These
children may have lower self-respect, and can experience difficulties in completing even the
simplest work (Kranowitz, 1998; Bahr, 2001).
Vestibular system is related to the perception of the signals concerning the changes in the
heads movement and position. Inner ear structure (semi-circular channel) upholds the task
of perceiving these signals. People live unaware of the existence of this system as well as the
signals it creates. However, motor coordination, eye movements and body stance require
this system to function properly (Halker, 2001). Children with vestibular function disorder
demonstrate insufficient motor planning (praxis). Autistic children also present certain
movement disorders. Some autistic children have difficulty in accomplishing actions like
climbing, standing on one foot, walking a straight line and jumping. These children may
also experience difficulties in repeating an action consecutively, starting or ending the action
on their own.
These disorders can vary in complex and simple movements (like flawy facial impression or
body dangling). Variant movement disorders are determined for autistic individuals. These
disorders can be categorized as follows;
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1.
Motor function disorders: Flexion dystonia, strained flexion in the hip and body, bizarre
body posture, gnashing, making a grimace arbitrarily, anti-social facial impression, lack
of eye contact, involuntary motor twitches, dyskinesia, motor stereotypes, vocal and
verbal twitches, keeping arms stable when walking and other joint movement deficits
can be evaluated in this category.
2. Intentional movement disorders: Slow moving, weakness in spontaneous movements,
motor planning difficulties, consecutively repetitive spontaneous actions, examining
objects by smelling, touching or tasting, walking disorders (walking slow, on tiptoes, on
heel or by jumping) are in this category.
3. Comprehensive behavior and activity disorders: Catatonic movements, oversensitivity to
environmental changes, aggression, hyperkinesis (hyperactivity), actions that include
explosives and violence, indisposition to physical contact and interaction, suddenly
stopping when performing an action, mutism (inability to speak), lack of ability to
imitate, inability to start a movement on their own and negativism can be included in
this group (Leary & Hill, 1996).
Autistic children usually provide disoriented responses to vestibular stimulants. These
children generally experience visual and vestibular coordination difficulties. It is believed
that vestibular systemic disorders can be related to problems in focusing or gravitating
towards visual stimulants. Sensory information input disorders (modulation) are considered
the first symptoms of autism. Communication and language disorders in social interactions
stem from the difficulty in balancing the sensory output. These children frequently tend to
engage in stereotypic actions to regulate sensory system (Case-Smith & Brayn, 1999;
Korkmaz, 2000b).
Leo Kanner states that autistic children demonstrate normal motor development. These
children show no abnormalities in physical appearance, but show variations in motor skill
development in comparison to the contemporary. Research indicates that autistic children
demonstrate difficulties in motor functions such as balance and movement, slow moving in
later periods, decrease in stance consistency and oral motor disorders (Jansiewicz et al., 2006;
Minshew et al., 2004; Page & Boucher, 1998) to distinguish from (Ozonoff et al. 2008).
However, researches comparing autistic children with other groups in terms of intelligence
development deficiency show no difference with respect to motor skills. Reids (1985) study
determined no difference between autistic and retarded children in terms of actions like
catching, jumping, hurling, running and balance. In a recent study conducted on 21-41
month old autistic children and retarded children defined no difference between the groups
in terms of object manipulation, perception and visual motor integration (Provost et al.,
2006). Similarly, Rogers et al. found no differentiation between 2- year old autistic children
and typical and atypical groups consistent in development in terms of fine motor
development and motor planning. (Rogers et al., 2003).
Although autistic children appear capable of developing numerous physical skills in time,
some skills may develop very late. Motor skill development in autistic children is usually
close to their chronologic age. These children may especially experience difficulties in
executing an action in line with an instruction and consecutively. For instance; their lack in
fine motor skills like paper cutting and putting cubes into a box are significant. Motor
problems observed in autistic children are related to motor coordination problems. It is also
expressed that their motor readiness levels for executing an action are low in comparison to
the contemporary (Berninger & Rutberg, 1992; Attwood, 1998; Ryoichiro et al., 2000;
Beversdorf et al., 2001).
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It is important to include exercises supporting basic movement skills in training programs

for autistic children. Attaining movement experience provides children with essential
information for perceiving their own body and recognizing the environment. Also,
movement training can be useful for improving the childs ability to solve problems,
expressing him/herself and seeking creative solutions to problems. Movement training can
also be used to develop skills such as paying attention, focusing and mediating. Children
can attain emotional and social gains through movement training. Through well-planned
movement training, children can develop abilities to recognize other children, act in
coordination and establish cooperation (Eichstaedt & Lavay, 1992).
Studies conducted in this subject prove that it is difficult for handicapped children to
discover their environment through games and movement if left alone. Therefore, it is
essential to assist the child in attaining various movement experiences. Learning basic
movement skills is also important for the child to learn more complex behaviors.
Development of these skills constitutes a foundation for the development of other body
movements and attaining complex movements. Basic movement training can be provided
through simple movement experience attained from exercise programs. In later periods, the
child can be diverted to sportive and recreational activities. Thus, guiding autistic children
to any branch of sports (especially swimming etc.) before school age can enable a positive
development (Connor, 1990; Cornish & McManus, 1996; Darca et al., 2000; Korkmaz, 2000b).
4.5 Proprioceptive systemic problems
Proprioceptive system provides information about the movements and the body position.
This system assists the integration of signals concerning touching and movement.
Proprioceptive signal receptors are situated in tissue connection spots in the muscles and
joints. This is required for skills like catching or throwing a ball and ladder climbing.
Proprioceptive system functions; the system contributes to body awareness, motor planning
and motor control. Proprioceptive system is also influential in body language and effective
control of body parts. It enables abilities like straight walking, sprinting, ladder climbing,
carrying a luggage, sitting, standing, and leaning upside down. It also assists in feeling
emotionally safe. Proprioceptive system means the perception of unconsciously executed
body actions (for instance; automatically sitting straight on a chair). In addition, conscious
body positions are frequently engaged. Developing body awareness also forms the childs
computative and mathematics skills (Fisher, 1991; Kranowitz, 1998; Bahr, 2001).
In the presence of proprioceptive systemic disorders, the child may not attain sufficient
information concerning the body position and body parts. Proprioceptive system is also
necessary in attaining the information needed for regulating the movements concerning
gross and fine motor skills. Children with proprioceptive problems may have trouble in
executing an action coordinately. For instance, the child may have difficulty in switching
from one action to another (Kranowitz, 1998).
Proprioceptive system allows us to distinguish between the actions. Distinguishing between
actions refers to feeling the magnitude of pressure that causes muscle contractions and
relaxation. During an activity; we can predict the quantity and quality of muscle
movements. Thus, we can adjust the amount of energy to be assigned when lifting a light
ball or a heavy bucket. When this system malfunctions, the child cannot receive sufficient
signals from the muscles and joints, consecutively failing to distinguish between the actions.
Proprioceptive system also provides information about unconscious body movements such
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as sitting and standing up. Children who are experiencing problems with this system may
have difficulty in adjusting their posture during daily activities. Proprioceptive system is
also essential in developing emotional confidence mechanism. Children with such disorders
can develop insufficient self awareness. Consequently, the child will lack the emotional
confidence (Kranowitz, 1998).
Proprioceptive disorder is usually accompanied by tactile and vestibular system disorders.
Children with proprioceptive disorder have difficulty in interpreting perceptions
concerning the position and movements of head, arms and legs. These children receive
common instinctual perceptions insufficiently. Since they have problems with fine and gross
motor muscle control and motor planning, their body awareness and body position
perception are also insufficient. These children may be very clumsy. They may attack
everyone and everything. They may cause conflicts when walking on a street, having bath
or playing in the garden. They also experience difficulties in managing objects. When
gripping an object, they apply excessive or insufficient pressure (For instance, they oftly
break pencil leads and their toys). They also have problems carrying a heavy object (For
instance; they have difficulty when carrying a bucket). Since they lack fine body awareness,
they need to follow their own body movements with eyes. They cannot complete even the
simplest actions like directing the body when getting dressed, buttoning up or pulling the
zipper without visual assistance. Since they lack fine postural balance, they may be afraid to
move within an area. Each new movement and position may startle them, consecutively
causing emotional insecurity (Kranowitz, 1998; Bahr, 2001).
Proprioceptive system constitutes joint, muscle and body awareness. Autistic children
usually experience insufficiencies in fine and gross muscle skills. These skills are disorders
that are included in the proprioceptive system. Most autistic children do not recognize their
body position in the space. Consecutively, they may be relieved by jumping on the
trampoline and riding on a swing. Some children may enjoy massage and deep pressure.
These activities may assist in motivating and reorganizing the child before learning new
skills (Halker, 2001).
5. Sensory integration operating scope and effects on autistic children

In sensory integration treatments prepared for autistic children, it is important to prioritize
that the family understands the childs behaviors, and emotional needs so as to provide the
necessary environmental regulations in the school and at home as well as allowing the child
to organize and utilize the signals received from the environment (Williamson & Anzalone,
1997).
The fundamental aim of sensory integration treatment is ensure that the child controls
sensory stimulants -especially inner ear balance system (vestibular)- received from the
muscles, joints and skin in order to allow the child to reform the corresponding reactions
that integrate these senses. Children with advanced handicaps, -especially autistic childrenare likely to need more instructions than others. When conducting treatment for these
children, stimulants needed by the child must be provided at the same time performing
exercises to permit the child to realize his/her own emotions. The aim of this therapy is not
teaching motor activities, but to assist the child in attaining motor skills, academic skills and
positive behaviors necessary throughout the life (Temel, 1992).
In a case of sensory integration deficiency, the child must be evaluated before initiating
treatment. When conducting the evaluation, sensory perception deficiencies, effects or
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sensory perception deficiencies on motor skills and the level of sensory integration
development must be determined. This evaluation will provide necessary information about
the child. This will ensure information about whether the child needs this kind of treatment,
or on which course he/she will need intensified therapy. Evaluation should include the
following courses;
Fine and gross motor development level
Visual motor integration (such as making jig-saw, copying figures)
Visual perception
Neuromuscular control (balance and posture)
Response to sensory stimulant (tactile, vestibular, proprioceptive)
Bilateral coordination
Motor planning.
When it is understood that the childs problems can be explained using sensory integration
theory and setting special targets, treatment can be initiated. Some children may
demonstrate a lack of enthusiasm for participating in activities within the treatment course.
Others may orally express reluctance to engage in an activity. Activity may be boring or too
simple for the child. Therefore, the first course of action must be investigating the reason for
the childs lack of motivation. If the planned activity is difficult for the child, it must be
adjusted for his/her skill level. If the child thinks the activity is difficult even if it is not,
he/she must be encouraged. While encouraging, the child must never be forced. If the
underlying cause of the childs lack of motivation is hypersensitivity, the child must be
given time to calm down.
Another important issue in the treatment is when to conclude the activity. If the child is
participating in an activity that helps the child to attain adaptive skills, the activity should
be sustained. The therapist should follow the childs guidance in decision-making.
In correcting problems about tactile system, the first action must be to determine whether
the child is hypersensitive or hyposensitive. Consecutively, activities that can solve the
problems should be selected. Examples for these activities can be; massage, hugging,
pressuring, brushing or scrubbing the legs, hands and back as well as books that encourage
touching, sand, beans, rice game, salt ceramics, drawing different figures using shave foam,
rolling on different surfaces, playing with blowing toys, drinking juice using pipette and
chewing. Through these activities, the childs hypersensitivity or hyposensitivity can be
curbed. Therefore, the child can achieve different tactile experiences (Kranowitz, 1998).
Autistic children with vestibular systemic problems may demonstrate motor planning and
motor coordination problems. The child must be evaluated to determine these problems.
Subsequent to the evaluation, appropriate activities should be selected. Activities like
standing on one foot, walking the balance plank, swinging on the balance plank and riding
on a swing can be provided for the child to improve balance sensation. In addition, the child
can be encouraged to extend his/her experience by imposing activities like straight walking,
variant walking imitations, somersaulting and climbing. Sensory vulnerability can be
treated through providence of different experiences. Therefore, the childs needs must be
determined in order to plan the program correspondingly (Kranowitz, 1998).
Autistic individuals with proprioceptive vulnerability may demonstrate problems like
postural dysregulation, frequent falling, failing to adjust limbs when getting dressed and
inability to carry heavy objects. The child must be supported with activities to improve
proprioceptive system so as to overcome these problems. Examples for these activities can
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be; riding the magic carpet, weight lifting (weights attached to hands, ankles and back) rope
skipping, jumping on the trampoline, walking with a wheelbarrow, crawling games and
dragrope game (Kranowitz, 1998).
6. Examples activities for sensory motor skill assistance

GOAL: Enabling interaction with objects of different attributes.
Expected Behavioral Gain:
1. Touching objects with different attributes.
2. Gripping objects with different attributes.
3. Walking on objects with different attributes.
4. Distinguishing between objects with different attributes.
Material: Bread paste, pudding, dry legumes, fresh fruits and vegetables, bowls.
1. Activity: Trainer sits the child down on a table in face to face position, places the foods
in large bowls. While touching the food, trainer gives the command touch. Trainer is
to encourage the child to touch food types of different structures (bread paste, pudding,
dry legumes, fresh fruits and vegetables). First, the trainer touches different types of
foods, places the food on the childs palm and fingers, then asks the child to touch the
food. While holding the childs hand, the trainer touches the food with the child. For the
first attempt, the timeline should be limited to 2 minutes. Then, the time given for
touching the child is gradually increased up to 10 minutes.
Material: Walking track.
2. Activity: Tracks made of different materials (e.g. rope, felting, plastic, emery, carpet,
sand) are prepared. Trainer sets example for the child by walking the track. Then, the
child is asked to walk the track from the start line till the finish line. Trainer assists the
child by walking together while holding the childs hand. The practice is sustained until
the child attains the ability to walk the track independently.
Material: Shag, velvet, flax and cotton materials.
3. Activity: Trainer sits down on the ground with the child in face to face position. Using
gloves made of different materials (shag, velvet, flax, and cotton); trainer touches the
childs limbs and face. While touching the child with the material, trainer counts from
1 to 10, later concludes the training. Trainer then uses as different material. Later, the
child is directed to touch objects made of metal, wood, plastic, emery and glass. In
follow up, the objects are placed in a box with all sides closed and round holes on the
front side; the child is asked to reach into the box to grip and distinguish the objects
(hard, ragged and soft) without looking. In the first stage of the activity, two objects
(like a toy or ball) are placed in the box. These must be objects the child is familiar
with.
Material: Touch box, hard, ragged and soft objects.
4. Activity: The child is asked to reach into the box to find and distinguish between the
objects with different attributes (hard, ragged and soft). The child is orally and
physically encouraged to distinguish between the objects. Trainer reaches into the box
with the child, touches the objects and talks about their attributes. Trainer may point to
the distinctive attributes of the objects. The childs behaviors are continuously rewarded
with incentives in the first stage. In later stages, support and incentives are reduced.
Incentives are only awarded when the child presents the correct answer.
Material: Sand pool, ball, toy car, cube.
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Activity: Trainer sits down in the sand pool with the child in face to face position.
Trainer shows an object to the child (such as toy car or cube). Then, the trainer hides
the object in the sand and asks the child to find the object, encourages the child to
find it. At first, the trainer finds the object and shows it to the child. Then, the object is
placed in the same spot and the child is asked to find it. Trainer may hold the childs
hand to pluck out the object. After attaining the ability to pluck out the object from
the sand, the object is placed in different spots and the child is asked to find it. At
first, the object is partially hidden so that the child can easily find it. Once the child
independently finds the object, the number of objects hidden in the sand is gradually
increased up to five.
Material: Heat tablets, water with different heat levels.
6. Activity: Trainer sits down with the child in face to face position. Plastic bottles of water
with different temperatures (cold, warm, hot) are placed in front of the child. Trainer
accompanies the child in touching bottles with different temperatures. Then, water with
different temperature is placed in large cups. Accompanying the child, the trainer dives
limbs inside the water cups with different temperatures. The trainer encourages the
child orally and physically to touch the water. Then, the trainer places heat tablets with
varying temperatures on the table and encourages the child to look at the tablets. While
supporting the child physically, trainer touches the tables with different temperatures
along with the child in order to improve touching behavior.
GOAL: Developing fine motor skills.
1. Imitating fine motor movements.
2. Imitating objects and movements.
3. Forming shapes using blocks.
4. Stringing beads.
5. Using the scissors.
6. Placing screws on the board.
7. Copying symbols.
1. Activity: Trainer sits on a chair facing the child. Trainer sets an example by performing
the action the child is expected to imitate. Then the child is given do it command
(clapping, opening and closing hands, tipping with index fingers). If the child cannot
perform the action, the trainer should provide physical assistance (for instance; helping
the child to clap by holding his/her hands). Trainer gradually decreases the physical
assistance to the child. The training is sustained until the child can independently
perform the instructed action.
Material: Bell, blocks, bucket.
2. Activity: Trainer sits on a table with the child in face to face position. Two identical
objects are placed on the table (e.g. two bells). Trainer takes one of the bells to ring it
when the child is paying attention to the trainer, then asks the child to perform the
same action. Trainer provides the child with You do it command. If the child cannot
perform the action, the trainer should hold his/her hand to help doing it. Then, the
action is performed repeatedly. Trainer should gradually reduce the assistance. In
follow up, the trainer should direct the child to practice with different objects in a
similar course of action (e.g. placing blocks in a bucket).
Material: Two triangles, two cylinders, blocks.
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3.
Activity: Trainer sits on a table with the child in face to face position. Similar blocks are
placed on the table (e.g. two triangles, two cylinders). Trainer constructs a structure
using blocks. Then the child is instructed to do the same using the block sets. While
constructing structures using the blocks, physical guidance is provided to the child. In
the first phase of the practice, one block at a time is placed (For instance; five blocks are
placed on the table to the childs right). One block is brought to the middle of the table.
The child is asked to select the same block and put it in the middle of the table. Trainer
places different shapes of blocks and asks the child to imitate the same structure.
Material: Beads and strings.
4. Activity: Trainer sits on a table with the child in face to face position. Varying sizes of
beads and strings with varying thickness are placed on the table. Training starts with
big sized beads. Trainer sets an example for the child by stringing a big sized bead, then
asks the child to do the same. Trainer holds the string and assists the child to place the
beads by holding the childs hand. Then the bead and the string are given to the child. If
the child cannot perform the stringing, physical assistance should be provided. Practice
continues with different types of beads.
Material: Scissors and papers.
5. Activity: Trainer sits on a table with the child in face to face position. Trainer takes the
scissors and sets an example for the child on how to use it, then encourages the child to
do the same. When the child attains the ability to use the scissors, trainer helps the child
practice using the scissors on cardboards or papers. When the child is able to use the
scissors independently, the trainer instructs the child to practice straight, round, square
and photo cuttings. During the practice, the child is instructed with do it like this
command. The child is encouraged with oral and physical hints to perform the cutting.
The childs actions are rewarded.
Material: Different sizes of screws and a board.
6. Activity: Trainer sits in front of the board alongside the child. Trainer takes a screw and
places on the board, then gives the screw to the child and commands you do it. The
child is encouraged to perform the action. Then, the child is supported to place different
sizes and numbers of screws on the board. When the child attains the ability to place
different sizes of screws on the board, the trainer instructs the child to practice in forming
patterns using the screws on the board. It is important to use big sized screws at first.
Material: Paper, shaving foam, finger paint and colored pastels.
7. Activity: Trainer places the drawing materials on the table where the child can see them.
Using large papers, drawing practice begins. The child is encouraged to copy different
patterns, digits and letters using different materials (such as working with finger paint,
shaving foam and sand). Physical support should be provided as the child practices
drawing and the childs drawings should be rewarded. Visual tips (e.g. dots) should be
used to make the drawings easier to see. Later, the dots are removed and the child
instructed to perform the correct drawing after seeing the example. The child should be
encouraged to draw by holding his/her hand or giving instructions like top-down or
left-to-right. Trainer practices with the child on drawing lines from simple to complex
(such as horizontal drawing, vertical drawing, plus shape drawing, x shape drawing,
writing letters on a straight line, drawing digits, drawing figures, drawing a childs
face, drawing flowers, cars, a home, a labyrinth and human figures). Training is
sustained until the child can draw the lines independently.
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GOAL: Developing gross motor skills

1. Imitating gross motor actions.
2. Participating in walking exercises.
3. Participating in running exercises.
4. Ball game.
5. Rolling.
6. Riding on a swing.
7. Climbing.
Material: The childs favorite food.
1. Activity: Trainer sits on a table with the child in face to face position and sets an
example of the motor actions the child should perform (tipping on the table, clapping,
stomping). Then, the trainer gives the child do this command. The child should be
encouraged orally and physically to perform the action. Trainer should provide various
incentives (e.g. chips, well done) for the childs effort to imitate the action and
responses. Then the support in the training session should be gradually decreased.
Incentives should be provided until the childs imitations become second nature.
Material: Colored adhesive tape.
2. Activity: The child is allowed to walk freely in a movement-free environment. A thick
line is drawn on the ground (using colored adhesive tape). The trainer gives the child
walk command. Trainer waits for the child to walk the line without stepping outside
the line. Then, trainer instructs the child to practice rhythmic walking, tip-toe walking,
heel-top walking, walking on the feets outside, walking on the feets inside and
walking to a specific object (trainer commands walk to the door). The child should be
encouraged to perform the appropriate action. The childs actions should be rewarded
with incentives. In later sessions, support and incentives should be reduced to positive
behaviors only.
Material: Rope, tape, chalk.
3. Activity: A circle is drawn on the ground with a large and thick line (using the rope,
tape or chalk). The child is instructed to walk step by step and side by side before
moving out of the line. The child should be encouraged to walk (trainer first sets an
example for the child and provides physical and oral tips). The trainer should reward
the childs actions with incentives. Later, the support and incentives should be reduced
and only provided when the child achieves the goal.
Material: Rope, tape, chalk.
4. Activity: A zig-zag is drawn on the ground with a thick line (using rope, tape or chalk).
The child is asked to walk the zig-zag without stepping out of the line. The child should
be encouraged to walk and rewarded for his/her actions. In later sessions, the support
and incentives should be reduced to accomplishing the track only.
Material: Ladder, different sizes of circles and boxes.
5. Activity: A walking band in the shape of a ladder is placed on the ground and the child is
asked to walk by stepping inside the band only. The child should be encouraged to walk
and rewarded for his/her actions. In later sessions, support can be gradually reduced in
accordance with the childs need. Incentives should only be provided when the child
completes the training. Walk by stepping in it practice should be extended to materials
with different shapes and depths (such as colored circles, different sizes of boxes).
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Material: Slalom sticks, traffic cones.

6. Activity: Objects are placed on the ground in a line allowing the child to walk in
between (e.g. slalom sticks and traffic cones). The child is asked to walk through the
objects. Trainer should set an example for the child to perform the action. The child
should be encouraged to walk and rewarded for his/her actions.
Material: Ball.
7. Activity: Trainers stands facing the child. The child is given an object (a ball). The child
is encouraged to walk the track and rewarded for his/her actions. As the amount of
time the child walks decreases, support and incentives should be reduced. Later, the
child should only be rewarded when he/she reaches the destination while holding an
object. Then, the child is encouraged to walk with a filled object (a filled plate, a glass
full of water) and rewarded for his/her actions. The support and incentives should later
be reduced. The child should only be rewarded when he/she reaches the destination
while holding an object.
Material: Balance plank.
8. Activity: The child is asked to climb up and walk the balance plank (20 cm above
ground, 15cm wide and 2 mt long). The child should be supported in climbing and
walking the plank. The childs actions should be rewarded. In later training sessions,
the support and incentives should be reduced. Incentives should only be provided if the
child can independently climb the plank and walk to the end.
9. Activity: Trainer sets an example for the child to imitate the walking of different animals
such as; lamb walk, frog walk (jumping when crouched), duck walk (taking a step
when crouching). Then the child is asked to imitate these movement patterns. The
trainer should physically and orally encourage the child to perform the actions. In
accordance with the childs ability to perform the actions, the support and incentives
should be gradually reduced. Incentives should only be provided when the child
achieves the imitated walking.
7. References
Anonim. (2003). Otizm. Otistik Cocuklari Koruma ve Yonlendirme Dernegi Yayinlari, 63 s.,
Izmir.
Attwood, T. (1993). Unusual behaviors associated with autism. Health Visitor, 66: 402-403.
Attwood, T. (1998). Aspergers sendrome: a guide for parents and professionals. Jessica
Kingsley Publishers Ltd., 223 s., London and Philadelphia.
Bahr, D. (2001). Oral motor assessment and treatment: ages and stages. Allyn & Bacon, 274
s., Boston.
Bauman ML, Kemper TL. (2005). Neuroanatomic observations of the brain in autism: a
review and future directions. Int J Dev Neurosci; 23:1837.
Belmonte, M. (2000). Abnormal attention in autism shown by steady-state visual evoked
potential. The International Journal of Research & Practice, 4(3); 269-286.
Berninger, V. W. and Rutberg, J. (1992). Relationship of finger function to beginning writing:
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Edited by Dr. Mohammad-Reza Mohammadi
ISBN 978-953-307-494-8
Hard cover, 478 pages
Publisher InTech
Published online 15, September, 2011
Published in print edition September, 2011

The aim of the book is to serve for clinical, practical, basic and scholarly practices. In twentyfive chapters it
covers the most important topics related to Autism Spectrum Disorders in the efficient way and aims to be
useful for health professionals in training or clinicians seeking an update. Different people with autism can
have very different symptoms. Autism is considered to be a spectrum disorder, a group of disorders
with similar features. Some people may experience merely mild disturbances, while the others have very
serious symptoms. This book is aimed to be used as a textbook for child and adolescent psychiatry fellowship
training and will serve as a reference for practicing psychologists, child and adolescent psychiatrists, general
psychiatrists, pediatricians, child neurologists, nurses, social workers and family physicians. A free access to
the full-text electronic version of the book via Intech reading platform at http://www.intechweb.org is a great
bonus.
How to reference
In order to correctly reference this scholarly work, feel free to copy and paste the following:
Yesim Fazlioglu and M. Oguz Gunsen (2011). Sensory Motor Development in Autism, A Comprehensive Book
on Autism Spectrum Disorders, Dr. Mohammad-Reza Mohammadi (Ed.), ISBN: 978-953-307-494-8, InTech,
Available from: http://www.intechopen.com/books/a-comprehensive-book-on-autism-spectrumdisorders/sensory-motor-development-in-autism
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Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

2. Definition and development of sensory integration

Sensory Motor Development in Autism

observed to stage hyperactivity or introversion (Temel, 1992). Body perception (body

A Comprehensive Book on Autism Spectrum Disorders

3. Effects of sensory integration deficiency

Brain may not receive senses due to connection failure.

Brain may receive sensory signals, but reception may be inconsistent.

Sensory Motor Development in Autism

The childs extraordinary answer to an ordinary question may reveal hypersensitivity,

Attention deficit hyperactivity disorder,

Hearing and language problems,

A Comprehensive Book on Autism Spectrum Disorders

4. Sensory problems in autistic children

Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

Failure to tolerate movement

Insecurity towards gravity.

Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

Sensory Motor Development in Autism

It is important to include exercises supporting basic movement skills in training programs

A Comprehensive Book on Autism Spectrum Disorders

5. Sensory integration operating scope and effects on autistic children

Sensory Motor Development in Autism

Fine and gross motor development level

Visual motor integration (such as making jig-saw, copying figures)

Neuromuscular control (balance and posture)

Response to sensory stimulant (tactile, vestibular, proprioceptive)

A Comprehensive Book on Autism Spectrum Disorders

6. Examples activities for sensory motor skill assistance

Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

Sensory Motor Development in Autism

GOAL: Developing gross motor skills

A Comprehensive Book on Autism Spectrum Disorders

Material: Slalom sticks, traffic cones.

Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

Sensory Motor Development in Autism

A Comprehensive Book on Autism Spectrum Disorders

A Comprehensive Book on Autism Spectrum Disorders

Published online 15, September, 2011

Published in print edition September, 2011

University Campus STeP Ri

Unit 405, Office Block, Hotel Equatorial Shanghai

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